Organ System-based Curriculum Research Articles

An experimental study: An integrative strategy of PBL combined with an organ-systems-based curriculum to improve academic achievement and career maturity

This study aims to investigate the impact of integrating Problem-Based Learning (PBL) and Organ System-Based Curriculum (OSBC) on medical students' academic achievement and career maturity within the context of medical education. An experimental design was employed, involving students from a medical school in China. Participants were randomly assigned to either a control group with a traditional curriculum or an experimental group receiving an integrated PBL and OSBC curriculum focused on cardiovascular system diseases. The intervention spanned four weeks. The results indicate that the experimental group demonstrated significantly higher academic achievement immediately after the intervention compared to the control group. This improvement persisted in a follow-up test conducted one month later. Career maturity also improved in the experimental group, albeit with a less sustained effect. The study underscores the potential of integrated teaching strategies in medical education for enhancing critical thinking and practical skills. However, long-term improvements in career maturity may necessitate further refinement of teaching methods. These findings contribute to the ongoing discourse on effective medical education strategies and emphasize the importance of a comprehensive approach to prepare students for academic excellence and clinical competence. Future research with larger sample sizes and consideration of additional influencing factors is recommended to gain deeper insights into the dynamics of medical education.

Curriculum restructuring at Texas Tech Health Science Center Medical School: Evaluation and lessons learned

Texas Tech Health Sciences Center Medical School (TTUHSC, SOM) recently changed from a 2 years pre‐clerkship curriculum to a 1.6 year organ system‐based curriculum. This change was implemented to develop an integrated curriculum specifically comprising of horizontal integration across disciplines. In order to provide students with a “cutting‐edge” curricula, TTUHSC medical educators involved in pre‐clerkship curriculum thoroughly reviewed the “traditional” curriculum content and strategically aligned the content to avoid redundancies and enhance student learning. As a result of the restructuring, a block entitled General Principles was created. This is a foundational block that covers basic principles of biochemistry, cell biology, medical genetics, pharmacology, and microbiology. Historically, pharmacology and medical genetics are two content areas that occurred later in our “traditional” pre‐clerkship curriculum. Previously, principles of pharmacology (pharmacokinetics/dynamics) were introduced in the Infectious Diseases block, prior to lectures over antibiotics, and medical genetics was part of the second year Multi‐System Disorders block. Now, both of these content areas are incorporated into the second unit of the General Principles block and follow biochemistry, cell biology, and cellular transport lectures. The objective of this study was to evaluate the performance of this block, specifically the student performance on pharmacology and medical genetics topics. We hypothesized that incorporating pharmacology and medical genetics in a block that covers basic biochemistry and cell biology will enhance student performance. To achieve this goal and as part of our efforts to ascertain the potential effects of curricular restructuring on topic mastery, we compared the past and present performance of pharmacology (n=11) and medical genetics (n=7) based questions. For questions related to medical genetics, the overall performance was not significantly affected, 88% (“traditional” curriculum) versus 89% (p=0.54). In contrast, overall performance on pharmacology based questions saw a significant drop, 85% former curriculum and 80% new curriculum (p=0.02). Interestingly, performance on questions related to pKa values and drug excretion improved within the new curriculum, a potential benefit to presenting pharmacology topics following basic principles of biochemistry. In conclusion, the student performance on medical genetics questions, topic that was traditionally taught in year 2 of medical school, was not negatively impacted even though this topic is introduced earlier. At the moment, it is unclear if the overall drop in pharmacology performance is due to the content being placed earlier within the pre‐clerkship curriculum or simply content overload. As a new program is implemented, a period of decline in performance often occurs. Thus, we will continue monitoring student performance and lessons learned from this block will help us in making fine adjustments to this newly implemented curriculum.

A Qualitative Exploratory Study to Elucidate The Impact of Integration on Pre-Clinical Disciplines Compared to Disciplines-Based Curriculum

Introduction: While most of the institution in our country follow the Flexnerian model of medical education, only a handful of medical colleges have embraced the integrated medical curriculum. Literature on impact of integration on the preclinical disciplines is sparse. This study aims to elucidate the impact of integration on the preclinical disciplines, their content, teaching, learning, and assessment. Methods: This qualitative exploratory study was conducted at the University College of Medicine and Dentistry from July to September 2020. Twenty-one semi-structured interviews were conducted with the faculty members from pre-clinical disciplines (Physiology, Anatomy, Biochemistry, Pharmacology, Pathology, Forensic Medicine & Community Medicine). The data was recorded, transcribed, coded and thematic analysis was done by using Atlas Ti version 7. Results: The thematic analysis of the transcripts resulted in twenty subthemes, from which five themes emerged. The study revealed that the faculty of preclinical disciplines perceived that departmental identity has been compromised since the switch to integrated medical curriculum. But, the relationships, both intradepartmental and interdepartmental of preclinical disciplines have improved significantly. Moreover, the number and depth of topics has also been affected. But the students learning approach was of major concern for the respondents. The student’s performance in the assessments was affected due to their learning approaches. Even though the number of assessments were deemed adequate, the depth of assessments had been negatively affected as a result of integrated assessments. Conclusion: Integrated curriculum has profound impact on pre-clinical disciplines. Any institution that wishes to introduce a modular integrated curriculum should take into account the findings reported in this study. Keywords: preclinical disciplines, organ system-based curriculum, impact of integration, faculty perspective, exploratory study

Scope of organ system-based curriculum in the delivery of medical education: A critique

The role of basic science subjects in the making of a competent medical graduate and a health care professional is crucial and thus multiple number of approaches have been tried to merge basic science with clinical medicine. The organ-system based medical curriculum is a type of integrated teaching, which has been advocated and adopted across different medical curriculum and has delivered promising results, especially with regard to increasing the depth of medical knowledge and a comprehensive understanding of each of the organ systems. Even though, this form of curriculum has been adopted by different medical schools, we have to acknowledge that for getting the intended outcomes, loads of investment in terms of time and efforts are required for the successful planning, organization and implementation. In conclusion, the adoption of an organ system-based medical curriculum is an effective and a sound approach to curriculum delivery as it addresses the limitations of the traditional curriculum and also strengthen the relevance of basic and clinical medicine in the minds of the medical students.

Practice and reflection on the "organ-system-based" curriculum reform

The organ-system-based curriculum (OSBC) medical teaching model with the organ system as the main line closely links the basic medical curriculum with the clinical practice, and breaks the boundaries between different subjects. As this novel teaching model is still in the early stage in China, Chongqing Medical University pioneered to reconstruct the teaching system for OSBC teaching reform, including the great efforts to integrate e the traditional 24 courses into 12, and to allocate talents from various basic and clinical teaching departments to form a new integrated teaching team. In 2011, this new mode was implemented in a pilot class of students. The results showed the 2011 five-year pilot class showed more satisfaction than did the traditional teaching class [(92.5±4.6)% vs. (72.5±4.9)%, P<0.05]. Besides, the test scores of the pilot class and the traditional class were (80.0±3.6) and (71.0±5.9) respectively(P<0.05), and the failing rate was (3.7% in pilot class and 9.3% in traditional class(P<0.05). Since the pilot class perform better than the traditional one, the reform of OSBC was implemented for all five-year clinical medicine program in Chongqing Medical University in 2018. Key words: Medical education; Curriculum reform; Organ-system-based curriculum; Medical curriculum system

Practice on organ system-based integrated course reform of nervous system

Starting from the characteristics of nervous system, breaking the traditional subject-cen-tered teaching model, combining the nervous system-related basic and clinical courses, Chongqing Medical University has established a nervous-module organ-system integration curriculum since 2010. This new teaching model is introduced and practiced in 5-year outstanding medical class of Chongqing Medical Uni-versity. The new integrated curriculum guides students to learn knowledge from points to surface, helps them to combine knowledge vertically and horizontally, and simplifies the duplicate teaching content, so as to promote students to develop coherent and innovative thinking mode. Integrated curriculum pattern is an inevitable trend in medical education reform. Key words: Organ system-based curriculum; Integrated course; Nervous system; Teaching reform

Pathology Course Director Perspectives of a Recent LCME Experience: Preparation in an Integrated Curriculum With the Revised Standards

Preparation for a Liaison Committee of Medical Education (LCME) accreditation site visit is a daunting task for any medical school, particularly for medical schools that have adopted integrated curricula. The LCME accreditation is the standard that all US and Canadian allopathic medical schools must meet in order for the school to award the degree of medical doctor. The Uniformed Services University of the Health Sciences (USU) recently underwent a full-scale LCME accreditation visit that was conducted under the newly revised LCME standards and elements. The site visit occurred just 5 years after our school began implementing a totally revised, organ system-based curriculum. Preparing for a critical, high-stakes site visit shortly after transitioning to a totally revised, integrated module-based preclerkship curriculum presented an array of new challenges that required a major modification to the type of preparation, communication, and collaboration that traditionally occurs between course directors and departmental chairs. These included the need to ensure accurate, timely communication of curricular details to different levels of the academic administration, particularly as it related to the execution of self-directed learning (SDL). Preparation for our site visit, did, however, provide a novel opportunity to highlight the unique educational experiences associated with the study of pathology, as pathology traverses both clinical and basic sciences. Sharing these experiences may be useful to other programs that are either undergoing or who are preparing to undergo an accreditation visit and may also aid in a broader communication of the highlights or initiatives of educational activities.

Educational Research and Evaluation at XUSOM

Educational evaluation is the process of characterizing and appraising certain aspects of the educational process. Educational research attempts to solve a problem, gathers new data and requires careful observation, rigorous analysis and expertise. Xavier University School of Medicine follows an integrated, organ system-based curriculum during the basic science years of the undergraduate medical (MD) course. Educational evaluations are routinely conducted in the institution and the results are used to further improve teaching-learning. A number of educational research projects have been conducted at the institution over the last two years and the results have been published. The results from these studies are shared with faculty members and the curriculum committee and utilized to further improve teaching-learning. In this article the author mentions some of these research studies and also addresses facilitating and hindering factors for educational research in the institution.

Challenges in Implementing an Integrated Curriculum in Xavier University School of Medicine, Aruba

Xavier University School of Medicine (XUSOM) is a private medical school in Aruba shifted to an integrated, organ system-based curriculum from January 2014. There is greater emphasis on problem-based learning, small group activities, early clinical exposure, and self-directed learning. In this article the author describes challenges faced while implementing the integrated curriculum. Among the challenges faced were faculty apprehensions about an integrated curriculum, faculty apprehensions regarding self-directed learning, providing early clinical exposure to the students, organizing activities and practical sessions for students, learning the art of medicine, developing student skills for critical appraisal of scientific literature and developing closer links with the community and the health system. The strategies adopted for overcoming some of these challenges is also described.

Student feedback about the integrated curriculum in a Caribbean medical school.

Purpose:Xavier University School of Medicine adopted an integrated, organ system-based curriculum in January 2013. The present study was aimed at determining students’ perceptions of the integrated curriculum and related assessment methods.Methods:The study was conducted on first- to fourth-semester undergraduate medical students during March 2014. The students were informed of the study and subsequently invited to participate. Focus group discussions were conducted. The curriculum’s level of integration, different courses offered, teaching-learning methods employed, and the advantages and concerns relating to the curriculum were noted. The respondents also provided feedback about the assessment methods used. Deductive content analysis was used to analyze the data.Results:Twenty-two of the 68 students (32.2%) participated in the study. The respondents expressed generally positive opinions. They felt that the curriculum prepared them well for licensing examinations and future practice. Problem-based learning sessions encouraged active learning and group work among students, thus, improving their understanding of the course material. The respondents felt that certain subjects were allocated a larger proportion of time during the sessions, as well as more questions during the integrated assessment. They also expressed an appreciation for medical humanities, and felt that sessions on the appraisal of literature needed modification. Their opinions about assessment of behavior, attitudes, and professionalism varied.Conclusion:Student opinion was positive, overall. Our findings would be of interest to other medical schools that have recently adopted an integrated curriculum or are in the process of doing so.

Curriculum reform at Chinese medical schools: What have we learned?

Introduction: Curriculum reform at Chinese medical schools has attracted a lot of attention recently. Several leading medical schools in China have undergone exploratory reforms and in so doing, have accumulated significant experience and have made considerable progress.Methods: An analysis of the reforms conducted by 38 Chinese medical colleges that were targeted by the government for upgrade was performed. Drawing from both domestic and international literature, we designed a questionnaire to determine what types of curricular reforms have occurred at these institutions and how they were implemented. Major questions touched upon the purpose of the reforms, curricular patterns, improvements in teaching methods post-reform, changes made to evaluation systems post-reform, intra-university reform assessment, and what difficulties the schools faced when instituting the reforms. Besides the questionnaire, relevant administrators from each medical school were also interviewed to obtain more qualitative data.Results: Out of the 38 included universities, twenty-five have undergone major curricular reforms. Among them, 60.0% adopted an organ system-based curriculum model, 32.0% adopted a problem-based curriculum model, and 8.0% adopted a hybrid curriculum model. About 60.0% of the schools’ reforms involved both the “pre-clinical” and the “clinical” curricula, 32.0% of the schools’ reforms were limited to the “pre-clinical” curricula, and 8.0% of the schools’ reforms only involved the “clinical” curricula. Following curricular reform, 60.0% of medical schools experienced an overall reduction in teaching hours, 76.0% reported an increase in their students’ clinical skills, and 60.0% reported an increase in their students’ research skills.Discussion: Medical curricular reform is still in its infancy in China. The republic’s leading medical schools have engaged in various approaches to bring innovative teaching methods to their respective institutions. However, due to limited resources and the shackle of traditional pedagogical beliefs among many faculty and administrators, progress has been significantly hindered. Despite these and other challenges, many medical schools report positive initial results from the reforms that they have enacted. Although the long term effects of such reforms remain unclear, curricular reform appears to be the inevitable solution to China’s growing need for high-quality medical doctors.

Who Wants to Be a Nervous System Infection Genius: A Case-Based Microbiology Game on Nervous System Infections

OPEN ACCESSNovember 18, 2013Who Wants to Be a Nervous System Infection Genius: A Case-Based Microbiology Game on Nervous System Infections Melphine Harriott, PhD Melphine Harriott, PhD Oakland University William Beaumont School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9617 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis interactive team-based game was developed to review nervous system pathogens during a neuroscience course in our organ system-based curriculum. It is a team activity that is intended for first- or second-year medical students. The game consists of nine short case studies with two or three associated questions per case, which teams answer with a team audience response system remote. Each question is assigned a point value, so that the team with the highest points wins the game. In between each case, there is a built-in instructor-facilitated discussion time, which ensures student questions or unclear concepts are addressed in a timely manner. This session provides students an opportunity to review microbiology in the context of the nervous system. The game atmosphere stimulates healthy competition between teams. However, because this session is non-graded, students are more relaxed and more willing to participate both in the small-group and larger classroom discussions. Finally, the use of the audience response system allows the instructor to receive real-time feedback on students answer choices and immediately clarify unclear concepts. Educational Objectives By the end of this resource, learners will be able to: Review clinical manifestations, pathogenesis, and laboratory diagnosis of select nervous system pathogens.Solve case studies involving pathogens of the nervous system. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor Guide.doc Key Points Worksheet.docx Nervous System Infection Game.pptx Question List.csv 2 Min Timer.mov Answers for Cases.xlsx Case 1 Meningococcus.docx Case 2 Group B Strep.docx Case 3 Aseptic Meningitis.docx Case 4 Cryptococcus.docx Case 5 Toxoplasma.docx Case 6 Listeria.docx Case 7 Botulism.docx Case 8 Tetanus.docx Case 9 Naeglaeria.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2013 Harriott. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsCerebrospinal FluidMicrobiologyNeurotoxinsMeningitisCentral Nervous System Infections Disclosures None to report. Funding/Support None to report. Loading ...

The Strategic Impact of a Changing Curriculum and Learning Environment on Medical Students' Academic Performance

In recent years, the administration of Meharry Medical College, School of Medicine (SOM), Nashville, Tennessee, recognized the need to modify the curriculum to help improve student academic performance especially on the National Board of Medical Examiners (NBME) US Medical Licensing Examination (USMLE) steps 1 and 2. Thus, a number of changes occurred with respect to the traditional curriculum in the SOM, resulting in an integrated organ system-based curriculum design.The change in the learning environment was studied to determine the impact on performance after the introduction of the integrated organ system-based curriculum as compared to that of the traditional curriculum. With the utilization of a cadre of variables, it was believed that the strategic impact anticipated would provide a predictive validity profile to assist in the identification of students "at risk" of failure so that proactive intervention methodology could be made available to facilitate the students' successful progression during matriculation in the SOM.The purpose of this study was to analyze whether students trained with the integrated organ systems curriculum perform better than students trained with the traditional medical school curriculum on the medical education preclinical subject board examinations, and the NBME USMLE steps 1 and 2 examinations.From the 584 students studied in the control group (graduation classes for years 2005, 2006, and 2007) and the intervention group (graduation classes for years 2008, 2009, and 2010), significant improvement in performance on the NBME USMLE steps 1 and 2 examinations was noted following the introduction of the integrated organ system-based curriculum particularly among "at-risk" students.Data access availability from the School of Medicine of Meharry Medical College automatically gave reason for a preferential comparative relationship and study of the resulting strategic impact on cohorts graduating in years 2005-2010. Thus, this longitudinal retrospective review was to determine whether or not students' academic performance profiles might provide some valid predictive information to help identify "at-risk" students early in their pursuit of a health professions career.

Neuroimmune Pharmacology as a Sub-discipline of Immunology in the Medical School Curriculum

This article provides a description of a proposed sub-module and attendant syllabus for inclusion of neuroimmune pharmacology as a sub-discipline of an immunology course that is offered to medical students during the first year of medical school. Neuroimmune pharmacology is an area of study that integrates fundamental concepts in pharmacology, immunology, neuroscience, and infectious disease. This convergent disciplinary area is of increasing importance to the foundational training of medical students, especially in view of the recognition that a variety of neuropathological processes such as demyelinating disease, drug abuse, and viral encephalitis has an immunological component. A lecture sub-module that addresses this convergent topic is proposed for inclusion as a sub-discipline of an immunology course offered as a component of a Scientific Foundations curriculum that takes place during the first 6 months of medical school. It is proposed to revisit the neuroimmune pharmacology topic area in a more clinical setting during the subsequent 14 months of study when medical students would be presented with an organ system-based curriculum. In this instructional model, basic science teaching faculty would interface with clinical faculty in presenting the topical block material in the context of different organ systems. Discussion of clinical cases related to neuroimmune pharmacology would be integrated into the organ system-based curriculum in order to highlight a translational relevance to medical practice.

Perspectives in Medical Education

Reform of medical education at Keio University has been underway since 2003. We measure the progress made since then in five specific categories that span fifteen recommendations presented in our "Blueprint for Reform" at the outset of the effort. These are effectiveness of leadership, curriculum reform, recognition of teaching, clinical competence, and comprehensive training in general internal medicine (GIM). First, effective leadership is being sustained through a succession of Deans, although a potentially crippling loss of leadership in the Department of Medical Education must be offset through timely appointment. Second, curriculum reform is awaiting the implementation in 2012 of an integrated, organ system-based curriculum with an emphasis on ward clerkships, but the introduction of PBL has been delayed indefinitely. Third, teaching is being recognized through the use of student feedback to reward good teachers and through funds for six full-time equivalent salaries dedicated to medical education, but promotions still depend exclusively on research, without consideration of teaching ability. Fourth, clinical skills training is still lacking, although enthusiasm for it seems to be building, thanks to the presence on the wards of a (still miniscule) cadre of dedicated teachers. Finally, exposure to GIM remains non-existent; however, visionary leadership in a newly-independent Emergency Department and the wide variety of medical problems seen there provide a remarkable opportunity to craft a uniquely Japanese solution to the problem. The changes implemented to date are impressive, and we remain enthusiastic about the future, even as we recognize the magnitude of the task that lies ahead.

Supporting the Academic Mission in an Era of Constrained Resources: Approaches at the University of Arizona College of Medicine

The authors describe initiatives at the University of Arizona College of Medicine to markedly expand faculty, build research along programmatic lines, and promote a new, highly integrated medical school curriculum. Accomplishing these goals in this era of declining resources is challenging. The authors describe their approaches and outcomes to date, derived from a solid theoretical framework in the management literature, to (1) support research faculty recruitment, emphasizing return on investment, by using net present value to guide formulation of recruitment packages, (2) stimulate efficiency and growth through incentive plans, by using utility theory to optimize incentive plan design, (3) distribute resources to support programmatic growth, by allocating research space and recruitment dollars to maximize joint hires between units with shared interests, and (4) distribute resources from central administration to encourage medical student teaching, by aligning state dollars to support a new integrated organ-system based-curriculum. Detailed measurement is followed by application of management principles, including mathematical modeling, to make projections based on the data collected. Although each of the initiatives was developed separately, they are linked functionally and financially, and they are predicated on explicitly identifying opportunity costs for all major decisions, to achieve efficiencies while supporting growth. The overall intent is to align institutional goals in education, research, and clinical care with incentives for unit heads and individual faculty to achieve those goals, and to create a clear line of sight between expectations and rewards. Implementation is occurring in a hypothesis-driven fashion, permitting testing and refinement of the strategies.

Inducing curricular change: initial evaluation of outcomes

Context and setting Data on interns obtained during their 1-year pre-registration service were used to induce curriculum change. The initiative resulted in a 5-year, semi-integrated, organ system-based curriculum implemented in 1998. It is the third curriculum to be initiated since our medical school was established in 1965. Why the idea was necessary In 1994, Ministry of Health consultants who supervised our graduates indicated that, although the graduates excelled in knowledge and skills, they lacked leadership qualities, interpersonal and communication skills, teamwork skills, and knowledge of medical economics and recent advances in medicine. What was done A curriculum review carried out in 1996 resulted in the New Integrated Curriculum (NIC). This consisted of 3 vertical strands: the scientific basis of medicine; personal and professional development (PPD), and doctor, patient, health and society (DPHS). The scientific basis of medicine curriculum covers appropriate content with reduced didactic teaching and increased student-centred and patient-oriented learning activities. The PPD strand addresses the development of appropriate attitude, character and ethics, with elective programmes included in all 3 phases. The elective programmes are aimed at developing managerial and research skills, and skills in oral, written and poster presentations. The DPHS module includes a community and family case study programme which exposes students to patients, their families and communities, and provides opportunities to practise medical ethics, communication and managerial skills, and to appreciate the psychosocial aspects of health and illness. A patient (under the care of a faculty member) and his or her family are assigned to a pair of students in Year 1 and this bond is maintained for 3 years. Problem-based learning (PBL) was introduced to further improve integration, communication skills, attitude and teamwork, and to emphasise clinical relevance early in the pre-clinical years. Evaluation of results and impact In 2004 and 2005, survey questionnaires were sent to consultants at 25 general hospitals 8 months into the intern postings (first and second cohorts). Self-rated competency surveys were completed by the students at the end of their final year. All the surveys used a 5-point Likert scale to indicate responses to the various statements related to both the outcomes achieved by interns and self-rated competency levels achieved in the final year. The consultants indicated that the NIC graduates had adequate knowledge and were competent (average score > 3.5) in history taking, clinical examination, differential diagnosis and patient management. Ratings of the graduates' communication skills, ability to work independently and within a team, and sensitivity to patients' needs were all > 3.6, validating the efficacy of the NIC goals. However, the graduates' performance in dealing with medical emergencies (3.4) and writing death reports (3.5) was regarded as less satisfactory and they were still considered to possess inadequate knowledge of medical economics (2.8) and insufficient awareness of recent advances in medicine (3.0). The feedback from hospital consultants was generally consistent with the findings from students' self-rated competency surveys. These initial data show that although the new curriculum has met many of its objectives, further work is required in some areas.